Universal Healthcare Detailed

Universal Health Care

 If healthcare is a human right, why isn’t it guaranteed in our state constitution?

The Problem

As Senator Bernie Sanders has often said, “”Health care is a human right.”  In fact, healthcare is just as important a right as education.

Yet no state has a constitutional amendment mandating healthcare for all its citizens.  Nor is there even a state constitution that offers a right to equal access to medical treatment for all of its citizens.

In fact, the United States is one of only two industrialized countries in the world that don’t have universal health care (the other is Mexico).

In 2015, even with the success of the Affordable Care Act (ACA), six percent of New Yorkers – over one million people — still had no health insurance.  The results of the 2016 election are sure to increase these numbers substantially as both the White House and the Congress insist on replacing the ACA.  The uninsured:

  • are less likely to have a usual source of care outside of the emergency room
  • often go without screenings and preventive care
  • often delay or go without needed medical care
  • pay more for medical care

This all results in more suffering, a higher death rate, and ultimately, greater social costs for a corrupt and inefficient system that enables huge disparities in health care access.

The Solution

New York needs a constitutional amendment that gives the right to health care for all New Yorkers and that the system must be a single-payer universal health care system for all New Yorkers. “Single-payer” means that the state, rather than private companies, pays all healthcare costs. In addition, there wouldn’t be “tiers of service” based on ability to pay.  Everyone would have access to the same healthcare.

Assemblyman Richard Gottfried, who chairs the Assembly Committee on Health, has already proposed “The New York Health program,” which would provide comprehensive, universal health coverage for every New Yorker and would replace private insurance company coverage (see below).

Fast Facts

  • “The uninsured have a higher risk of death when compared to the privately insured, even after taking into account socioeconomics, health behaviors, and baseline health,” said lead author Andrew Wilper, M.D., who currently (as of 2009) teaches at the University of Washington School of Medicine. “We doctors have many new ways to prevent deaths from hypertension, diabetes, and heart disease — but only if patients can get into our offices and afford their medications.” http://obamacarefacts.com/facts-on-deaths-due-to-lack-of-health-insurance-in-us/
  • “Talk of single-payer health care in the United States popped up in an unexpected place recently: the most recent Berkshire Hathaway annual meeting. “The whole system is cockamamie,” the company’s vice chair, Charlie Munger, declared. “I think we should have single-payer medicine eventually.” As for partner Warren Buffett, the man known by his fans as the Sage of Omaha, he called health-care costs “the tapeworm of American economic competitiveness” and claimed he “personally” supported a single-payer system.” –Helaine Olen, “Why Won’t More American Corporations Support Single-Payer Health Care?The Nation, May 22, 2017.
  • Life expectancy is shorter in the United States despite some relatively healthy life style practices. Americans, for example, drink less, are less likely to commit suicide, and are much less likely to smoke than residents of other OECD countries.   Americans, however, use the health care system less than do residents of other countries. They average only 4.1 physician consultations per person per year, compared to 6.7 for the rest of the OECD, and Americans have fewer and shorter hospital stays.—Economic Analysis of the New York Health Act.
  • Like other basic services such as education, police, fire protection, and roads, paying for health care should be a public responsibility. We should not be at the mercy of insurance companies and their ever-increasing premiums. Health care should be a basic right, not a privilege or a commodity. – Assemblyman Richard Gottfried, Single Payer Health Plan for New York.
  • “A broad national consensus is developing that health care is indeed a right. This is historically new. And it carries immense implications for the future. It suggests that we may be heading inexorably to a government-run, single-payer system. It’s what Barack Obama once admitted he would have preferred but didn’t think the country was ready for. It may be ready now.” – Charles Krauthammer, The Washington Post, “The Road to Single-Payer Health Care,” March 30, 2017.
  • A 2016 study by WalletHub rated New York’s healthcare system the 35th best when comparing healthcare costs, access and outcomes across the fifty states and the District of Columbia.

History

  • President Theodore Roosevelt was the first president to advocate for a national health system. There were some attempts to pass a healthcare bill during the Progressive Era, but they did not succeed.
  • In the 1940s, to avoid World War II wage-and-price controls, employers began offering health benefits instead of raises.
  • In 1943, President Franklyn Roosevelt proposed a ‘Second Bill of Rights’ that included: “The right to adequate medical care and the opportunity to achieve and enjoy good health.”  This also was not enacted by Congress.
  • In 1965, President Johnson got Medicare and Medicaid through the Congress.
  • In 1997, the State Children’s Health Insurance Program, now known simply as CHIP, was passed. Sponsored by Senators Kennedy and Hatch and supported by President Clinton and Hillary Clinton, the program was designed to cover children of families with modest incomes that were ineligible for Medicaid.
  • In 2010, the Affordable Care Act passes the Congress.

To this day, the United States is one of only two industrialized nations that does not guarantee universal healthcare access. (The other is Mexico.)  Evidence from countries with universal health care systems suggests that a universal scheme may lead to enhanced access to care, better health outcomes, and improved efficiency and equity.  For instance, Medicare, which is a single-payer plan, spends only 2 percent of its income on operating expenditures.  Private insurance, however, spends up to 17 percent – and takes a large profit as well.

It’s therefore no surprise that a 2016 Commonwealth Fund study of health systems in 11 industrialized nations ranked the US, the only country without universal health care, at the bottom, noting deficiencies with regard to cost, efficiency, equity, and healthy lives.

The lack of universal health care in the country, even after President Obama’s Affordable Care Act was implemented:

…the United States is unique in that medical bankruptcy, a leading cause of personal bankruptcy in the country, affects largely individuals who have insurance. Many Americans insured after the ACA have already expressed that the cost of care remains a significant barrier, because they cannot afford to actually use the policies they may afford to purchase.

The continuing problem of affordability was further revealed by the Commonwealth Fund study mentioned above.  The U.S. led the ten other Western nations studied with cost-related barriers to healthcare:

The study defines “cost=related access barrier to care” as “had a medical problem but did not visit doctor; skipped medical test, treatment, or follow-up recommended by doctor; and/or did not fill prescription or skipped doses.”

The inability to afford going to a doctor cost us dearly in other ways.  According to a recent study about New York Health done at the University of Amherst:

…every percentage point increase in the share of the population unable to see a doctor because of cost raises the age-adjusted mortality rate by over 1 percent. For Albany County, this means an extra 29 deaths; for the Bronx, 143; for Oswego, thirteen.

Assemblyman Richard Gottfried’s Proposal

Assemblyman Richard Gottfried has a bill that he has submitted previously in the Assembly which would create a single-payer system for the people of New York.  The plan would provide all New Yorkers coverage for “…all medically necessary services, including: primary, preventive, specialists, hospital; mental health; reproductive health care; dental; vision; prescription drug; and medical supply costs – more comprehensive than most commercial health plans.”

The health care plan would be paid for by a “tax on payroll and non-payroll taxable income, based on ability to pay.” This means that people with higher incomes would pay more than people with lower incomes.

A single-payer plan would save time and money on the part of patients, doctors and administrators who would only have to work with one, nonprofit system, rather than the myriad of insurance companies in the market.

An economic analysis of Assemblyman Gottfried’s proposal has been done by Gerald Friedman, PhD, chair of the Department of Economics, the University of Massachusetts at Amherst.  The analysis comes to the following conclusion:

By reducing burdensome billing expenses, administrative waste in the insurance industry, monopolistic pricing of drugs and medical devices, and fraud, the Act would save over $70 billion in 2019, 25% of that year’s projected health care spending, and savings will increase over time.

Currently, the bill has passed the Assembly and is waiting for a vote in the Senate.

Other States

No states currently offer their own healthcare plan for all their citizens.  However, one state had their own system before Obamacare.

Massachusetts

The state built a precursor to the ACA, “RomneyCare,” in 2006.  The program resulted in 97% of Massachusetts residents having healthcare.  The program ended with the advent of the ACA.

In the rest of the world, the United States and Mexico are the only industrialized countries without universal healthcare.  In fact, “Nations that have adopted single-payer systems cut across cultures, political ideologies, and levels of development.  They include countries as different as the United Kingdom, Iceland, Taiwan, Spain, and Cuba.”

Many critics of American healthcare compare our private system to Canada’s single-payer system. Canada’s system is often caricatured as being inefficient with long wait times for services.

This is not, however, the reality.  Philip Kotler, S. C. Johnson Distinguished Professor of International Marketing at the Kellogg School of Management at Northwestern University, has recently described the Canadian system:

Costs are paid through funding from income taxes. There are no deductibles on basic health care and co-pays are kept extremely low…One’s health coverage is not affected by loss or change of jobs, as long as premiums are up to date. There are no lifetime limits or exclusions for pre-existing conditions.

Canadians chose their family physician (called a general practitioner or GP). If the person wants to see a specialist, the GP will make a referral. The median wait time to see a specialist physician is a month. The median wait time for diagnostic services such as MRI and CAT scans is two weeks. The median wait time for surgery is four weeks.

Pharmaceutical medications are covered by public funds for the elderly or indigent, or through employment-based private insurance. The Canadian government negotiates drug prices with suppliers to control costs….

The main thing to notice is that Canada’s healthcare cost to its GDP is 11 percent whereas the U.S. cost is 17 percent of the GDP.

Resources

2016’s States with the Best & Worst Health Care,” by Richie Bernardo, Sep 6, 2016.

Economic Analysis of the New York Health Act,” by Gerald Friedman, PhD, April, 2015.

Facts on Deaths Due to Lack of Health Insurance in US,” Obamacare Facts.

Healthcare for All,” the New York State Nurses Association.

Here’s a Map of the Countries That Provide Universal Health Care (America’s Still Not on It,” by Max Fisher, The Atlantic, June 28, 2012.

In New Survey of 11 Countries, U.S. Adults Still Struggle with Access to and Affordability of Health Care,” The Commonwealth Fund, November 2016.

Is Health Care a Right? Health Reforms in the USA and their Impact Upon the Concept of Care,” by Mahiben Maruthappu, Rele Ologunde, and Ayinkeran Gunarajasingam, Annals of Medicine and Surgery, February 5, 2012.

It’s Time For A Single-Payer Healthcare System,” by Philip Kotler, The Huffington Post, March 25, 2017.

Mass. Ditches RomneyCare Exchange,” by Kyle Cheney, May 6, 2014.

Promoting Health as a Human Right in the Post-ACA United States,” by Andrea S. Christopher, MD, and Dominic Caruso, AMA Journal of Ethics, Volume 17, Number 10: 958-965, October 2015.

The Road to Single-Payer Health Care,” by Charles Krauthammer, The Washington Post, March 30, 2017.

Single Payer Health Plan for New York,” By Assembly Member Richard N. Gottfried Chair, NYS Assembly Committee on Health, May 1, 2013.

The State-Level Future of Healthcare Reform,” by Eric Schnurer, The Atlantic, April 10, 2015.

What is the Human Right to Health and Health Care?” National Economic & Social Rights Initiative.

Why Do Americans Still Need Single-Payer Health Care After Major Health Reform?” by Claudia Chaufan, International Journal of Health Services, Volume 45, Number 1, Pages 149–160, 2015.

Why Won’t More American Corporations Support Single-Payer Health Care?” by Helaine Olen, The Nation, May 22, 2017.